Individual provider Active NPI

Denise I. Fitzsimon, MD

  • Pediatrics Physician
  • Round Rock, TX
National Provider Identifier
1861525636
Registry record updated Nov 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
H1960 Issued in TX
Practice address
300 University Blvd
Round Rock, TX 78665-1032
Phone
(512) 509-0200
NPI assigned
Mar 13, 2007
Last updated
Nov 9, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 3954 AK
Pediatrics Physician 208000000X MD26536 OR
Pediatrics Physician 208000000X MD00046928 WA
Pediatrics Physician 208000000X H1960 TX Primary

Addresses

Primary practice location

300 University Blvd
Round Rock, TX 78665-1032

Mailing address

PO Box 844658
Dallas, TX 75284-4658

Other identifiers 2

IdentifierTypeStateIssuer
278407MedicaidOR
218112MedicaidOR

Other names 1

  • Denise I. Fitzsimon-Williams Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dfitzsimon1127337@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111222000304 OR Practitioner - Pediatric Medicine 1153412523 Reassigns benefits to 3 organizations
I20240320003203 CA Practitioner - Pediatric Medicine 1153412523 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
3954AKMDPediatrics Physician
MD26536ORMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Medical Foundation of Tillamook CurrentSince Mar 20, 2024 Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc Current Accepting new patients
Siskiyou Hospital, Inc. CurrentSince Feb 20, 2024 Accepting new patients
Commonspirit Oregon CurrentSince Nov 22, 2011 Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Feb 1, 2024 Accepting new patients
Commonspirit Oregon CurrentSince Nov 22, 2011 Accepting new patients
Northwest Medical Foundation of Tillamook Current Accepting new patients
Saint Alphonsus Medical Center- Ontario Inc CurrentSince Feb 1, 2024 Accepting new patients

Locations

444 Bruce St
Yreka, CA 96097
Phone (530) 841-6256

475 Bruce St
Yreka, CA 96097
Phone (530) 842-3507

1050 SW 3rd Ave
Ste 1600
Ontario, OR 97914
Phone (541) 881-2360

2801 St Anthony Way
Pendleton, OR 97801
Phone (541) 276-5121

1000 3rd St
Tillamook, OR 97141
Phone (503) 251-6129

1000 3rd St
#M
Tillamook, OR 97141
Phone (503) 815-2260

Interoperability endpoints

  • Direct secure messaging: dfitzsimon1127337@direct.sw.org
  • Direct secure messaging: dfitzsimon575934@direct.llu.edu

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1861525636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 UNIVERSITY BLVD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786651032",
            "telephone_number": "512-509-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZSIMON",
        "first_name": "DENISE",
        "middle_name": "I.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AK",
            "license": "3954",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OR",
            "license": "MD26536",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00046928",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "H1960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "278407",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "218112",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dfitzsimon1127337@direct.sw.org",
            "affiliation": "N",
            "address_1": "300 University Blvd",
            "city": "Round Rock",
            "state": "TX",
            "country_code": "US",
            "postal_code": "786651032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DENISE",
            "last_name": "FITZSIMON-WILLIAMS",
            "middle_name": "I.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Round Rock, TX

Sources for this page

Verify at the official NPI Registry.